Evaluation of Diffuse Myocardial Fibrosis in Heart Failure With Cardiac Magnetic Resonance Contrast-Enhanced T1 Mapping

Leah Iles, Heinz Pfluger, Arintaya Phrommintikul, Joshi Cherayath, Pelin Aksit, Sandeep N. Gupta, David M. Kaye, Andrew J. Taylor

Research output: Contribution to journalArticle

Abstract

Objectives: The purpose of this study was to investigate a noninvasive method for quantifying diffuse myocardial fibrosis with cardiac magnetic resonance imaging (CMRI). Background: Diffuse myocardial fibrosis is a fundamental process in pathologic remodeling in cardiomyopathy and is postulated to cause increased cardiac stiffness and poor clinical outcomes. Although regional fibrosis is easily imaged with cardiac magnetic resonance, there is currently no noninvasive method for quantifying diffuse myocardial fibrosis. Methods: We performed CMRI on 45 subjects (25 patients with heart failure, 20 control patients), on a clinical 1.5-T CMRI scanner. A prototype T1 mapping sequence was used to calculate the post-contrast myocardial T1 time as an index of diffuse fibrosis; regional fibrosis was identified by delayed contrast enhancement. Regional and global systolic function was assessed by cine CMRI in standard short- and long-axis planes, with echocardiography used to evaluate diastology. An additional 9 subjects underwent CMRI and endomyocardial biopsy for histologic correlation. Results: Post-contrast myocardial T1 times correlated histologically with fibrosis (R = -0.7, p = 0.03) and were shorter in heart failure subjects than controls (383 ± 17 ms vs. 564 ± 23 ms, p <0.0001). The T1 time of heart failure myocardium was shorter than that in controls even when excluding areas of regional fibrosis (429 ± 22 ms vs. 564 ± 23 ms, p <0.0001). The post-contrast myocardial T1 time shortened as diastolic function worsened (562 ± 24 ms in normal diastolic function vs. 423 ± 33 ms in impaired diastolic function vs. 368 ± 20 ms in restrictive function, p <0.001). Conclusions: Contrast-enhanced CMRI T1 mapping identifies changes in myocardial T1 times in heart failure, which appear to reflect diffuse fibrosis.

Original languageEnglish (US)
Pages (from-to)1574-1580
Number of pages7
JournalJournal of the American College of Cardiology
Volume52
Issue number19
DOIs
StatePublished - Nov 4 2008
Externally publishedYes

Fingerprint

Fibrosis
Magnetic Resonance Spectroscopy
Heart Failure
Magnetic Resonance Imaging
Cine Magnetic Resonance Imaging
Pathologic Processes
Cardiomyopathies
Echocardiography
Myocardium
Biopsy

Keywords

  • cardiac magnetic resonance imaging
  • cardiomyopathy
  • fibrosis
  • heart failure

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Evaluation of Diffuse Myocardial Fibrosis in Heart Failure With Cardiac Magnetic Resonance Contrast-Enhanced T1 Mapping. / Iles, Leah; Pfluger, Heinz; Phrommintikul, Arintaya; Cherayath, Joshi; Aksit, Pelin; Gupta, Sandeep N.; Kaye, David M.; Taylor, Andrew J.

In: Journal of the American College of Cardiology, Vol. 52, No. 19, 04.11.2008, p. 1574-1580.

Research output: Contribution to journalArticle

Iles, L, Pfluger, H, Phrommintikul, A, Cherayath, J, Aksit, P, Gupta, SN, Kaye, DM & Taylor, AJ 2008, 'Evaluation of Diffuse Myocardial Fibrosis in Heart Failure With Cardiac Magnetic Resonance Contrast-Enhanced T1 Mapping', Journal of the American College of Cardiology, vol. 52, no. 19, pp. 1574-1580. https://doi.org/10.1016/j.jacc.2008.06.049
Iles, Leah ; Pfluger, Heinz ; Phrommintikul, Arintaya ; Cherayath, Joshi ; Aksit, Pelin ; Gupta, Sandeep N. ; Kaye, David M. ; Taylor, Andrew J. / Evaluation of Diffuse Myocardial Fibrosis in Heart Failure With Cardiac Magnetic Resonance Contrast-Enhanced T1 Mapping. In: Journal of the American College of Cardiology. 2008 ; Vol. 52, No. 19. pp. 1574-1580.
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AU - Iles, Leah

AU - Pfluger, Heinz

AU - Phrommintikul, Arintaya

AU - Cherayath, Joshi

AU - Aksit, Pelin

AU - Gupta, Sandeep N.

AU - Kaye, David M.

AU - Taylor, Andrew J.

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N2 - Objectives: The purpose of this study was to investigate a noninvasive method for quantifying diffuse myocardial fibrosis with cardiac magnetic resonance imaging (CMRI). Background: Diffuse myocardial fibrosis is a fundamental process in pathologic remodeling in cardiomyopathy and is postulated to cause increased cardiac stiffness and poor clinical outcomes. Although regional fibrosis is easily imaged with cardiac magnetic resonance, there is currently no noninvasive method for quantifying diffuse myocardial fibrosis. Methods: We performed CMRI on 45 subjects (25 patients with heart failure, 20 control patients), on a clinical 1.5-T CMRI scanner. A prototype T1 mapping sequence was used to calculate the post-contrast myocardial T1 time as an index of diffuse fibrosis; regional fibrosis was identified by delayed contrast enhancement. Regional and global systolic function was assessed by cine CMRI in standard short- and long-axis planes, with echocardiography used to evaluate diastology. An additional 9 subjects underwent CMRI and endomyocardial biopsy for histologic correlation. Results: Post-contrast myocardial T1 times correlated histologically with fibrosis (R = -0.7, p = 0.03) and were shorter in heart failure subjects than controls (383 ± 17 ms vs. 564 ± 23 ms, p <0.0001). The T1 time of heart failure myocardium was shorter than that in controls even when excluding areas of regional fibrosis (429 ± 22 ms vs. 564 ± 23 ms, p <0.0001). The post-contrast myocardial T1 time shortened as diastolic function worsened (562 ± 24 ms in normal diastolic function vs. 423 ± 33 ms in impaired diastolic function vs. 368 ± 20 ms in restrictive function, p <0.001). Conclusions: Contrast-enhanced CMRI T1 mapping identifies changes in myocardial T1 times in heart failure, which appear to reflect diffuse fibrosis.

AB - Objectives: The purpose of this study was to investigate a noninvasive method for quantifying diffuse myocardial fibrosis with cardiac magnetic resonance imaging (CMRI). Background: Diffuse myocardial fibrosis is a fundamental process in pathologic remodeling in cardiomyopathy and is postulated to cause increased cardiac stiffness and poor clinical outcomes. Although regional fibrosis is easily imaged with cardiac magnetic resonance, there is currently no noninvasive method for quantifying diffuse myocardial fibrosis. Methods: We performed CMRI on 45 subjects (25 patients with heart failure, 20 control patients), on a clinical 1.5-T CMRI scanner. A prototype T1 mapping sequence was used to calculate the post-contrast myocardial T1 time as an index of diffuse fibrosis; regional fibrosis was identified by delayed contrast enhancement. Regional and global systolic function was assessed by cine CMRI in standard short- and long-axis planes, with echocardiography used to evaluate diastology. An additional 9 subjects underwent CMRI and endomyocardial biopsy for histologic correlation. Results: Post-contrast myocardial T1 times correlated histologically with fibrosis (R = -0.7, p = 0.03) and were shorter in heart failure subjects than controls (383 ± 17 ms vs. 564 ± 23 ms, p <0.0001). The T1 time of heart failure myocardium was shorter than that in controls even when excluding areas of regional fibrosis (429 ± 22 ms vs. 564 ± 23 ms, p <0.0001). The post-contrast myocardial T1 time shortened as diastolic function worsened (562 ± 24 ms in normal diastolic function vs. 423 ± 33 ms in impaired diastolic function vs. 368 ± 20 ms in restrictive function, p <0.001). Conclusions: Contrast-enhanced CMRI T1 mapping identifies changes in myocardial T1 times in heart failure, which appear to reflect diffuse fibrosis.

KW - cardiac magnetic resonance imaging

KW - cardiomyopathy

KW - fibrosis

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